Pneumococcal vaccination coverage at the initiation of chronic dialysis, and its association with mortality during the first year.

Abstract

Pneumococcal immunization is recommended in dialysis patients. We aimed to estimate pneumococcal vaccination coverage among patients who initiate dialysis in France, and its association with mortality. Data were extracted from two prospective national databases, merged using a deterministic linkage method: renal epidemiology and information network (REIN) registry, which includes all patients on dialysis and kidney transplants recipients in France, and the national health insurance information system (SNIIRAM) which collects individual data on health expenditure reimbursement, including vaccines. We enrolled all patients who initiated chronic dialysis in 2015. Data on health status at dialysis initiation, dialysis modalities, and pneumococcal vaccine prescribed from 2years before to 1year after dialysis start were collected. Univariate and multivariate Cox proportional hazard models were used to assess one-year all-cause mortality. Among the 8,294 incident patients included, 1,849 (22.3%) received at least one pneumococcal vaccine before (n=542, 6.5%), or after (n=1,307, 15.8%) dialysis start, as follows: 13-valent pneumococcal conjugated vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23), n=938 (50.7%); only PPSV23, n=650 (35.1%); or only PCV13, n=261 (14.1%). Vaccinated patients were younger (mean, 66.5±14.8years vs. 69.0±14.9years, P≤0.001), more likely to suffer from glomerulonephritis (17.0% vs. 11.0%, P≤0.001), and less likely to start dialysis in emergency (27.2% vs. 31.1%, P=0.001). On multivariate analysis, patients who received PCV13 and PPSV23, or only PCV13 were less likely to die (respectively, HR=0.37; 95%CI 0.28-0.51, and HR=0.35; 95%CI 0.19-0.65). Pneumococcal immunization with PCV13 followed by PPSV23, or with PCV13 alone, but not with PPSV23 alone, is independently associated with decreased one year-mortality in patients who start dialysis.